Sports Injuries in Children

Knowledge of a sport’s demands, lore, and jargon aids in understanding the athlete’s problems.

Ballet Dancing

Moderate risk. Reports of specific injuries, which include stress fractures of the pars, distal fibula, and base of the second metatarsal; Achilles tendonitis; cuboid subluxation; os trigonum impingement syndrome; and trigger toes. Toes are severely stressed. Delay in puberty and emphasis on slenderness is a problem for girls and can lead to eating disorders. Be aware that the dancer’s self-image is one of an artist, not an athlete, despite the high level of athletic demands.

Baseball

Moderate risk, depending upon the child’s age. Most acute injuries are associated with sliding, collisions, and ball or bat strikes. Most deaths occur from ball strikes to the head, neck, or chest. Overuse injuries, such as little league elbow, are preventable but potentially serious problems. Unusual injuries include apophysitis of the acromion, distal humeral epiphyseal separation, persistence of the olecranon physis, and avulsion of the iliac crest apophysis while swinging a bat.

Basketball

Moderate risk. Injuries as compared with other sports occur more often but usually are mild. Injuries in children under age 12 involve mainly contusions, sprains, lacerations, and rarely a fracture. Seldom are there serious injuries. Adolescent injuries are more common and more likely to be serious, such as contusions, sprains, and sometimes fractures. Ankles and knees are affected most. Most serious are ACL injuries. Ankle injuries require rehabilitation to prevent recurrence.

Cycling

High risk. Most serious accidents are due to collisions with motor vehicles. Prevention is essential through education of children, use of helmets, and avoidance of congested roadways. Potential long-term disability from head injury is significant.

American Football

High risk. Most injuries are due to collisions in this most risky sport. Catastrophic injuries can be reduced by using a well-fitting helmet and by avoiding spearing (initial head contact in blocking and tackling). A quarter of American football players are obese. Injury rates increase with maturation. Long-term osteoarthritis of the knee and hip are possible sequela from major injuries of these joints. Most problems result from acute injury and are due to joint and neurological damage. Try to control pushy coaches and educate parents.

Diving

High-risk. There is a risk of head and cervical spine injury with quadriplegia. Attention to diving height, water depth, and technique are essential in prevention.

Gymnastics

Moderate risk. Overuse injuries commonly produce spondylolysis and wrist problems. Wrist pain occurs in about 75% of gymnasts, and radiographic changes of the distal radial physis were found in 25%. Long-term problems may result from growth arrest of distal radial epiphysis and spondylolisthesis. The great focus on slimness may cause eating disorders and menstrual and growth problems in girls.

Ice Hockey

Moderate to high risk. Shoulder injuries are common from collision and puck and stick strikes. Protective gear is essential and has resulted in fewer facial lacerations. Head injuries and joint damage may lead to long-term problems.

Horseback Riding

Moderate to high risk. Injuries are due to horse handling and falls. Serious falls with head and neck injuries and fractures are common. Protective helmets and special training for handling horses can reduce risks. Horseback riding is proposed as therapeutic for children with cerebral palsy, scoliosis, and other conditions, but proof of effectiveness is lacking.

Playground

The playground can be a dangerous place for children. Soft surfaces and reduced height of playground equipment are important design features.

Running

Low to moderate risk. Overuse injury rates are high, but serious injuries are uncommon. Most injuries are preventable by appropriate training, shoes, and selection of proper running surface. Long-term sequelae are unlikely.

Skateboarding

High risk. Acute injury is common and is related to boards being difficult to control and being used on hard surfaces, unsupervised, with potential for collision. Skateboarders should use protective gear and avoid obstacles and high speed. Long-term sequelae risk is moderate and primarily results from head injury.

Moderate to high risk. Injuries are due to impact. More ankle and upper extremity injuries occur in this sport than in skiing, but there are fewer torsional, knee, and thumb injuries.

Skiing

Moderate to high risk. Jumping and racing injuries pose the greatest risks. Tibial fractures, medial collateral ligament injuries, and thumb and shoulder injuries are common. Collision injuries are the most serious, as head, spine, and extremity injuries may have long-term sequelae. The most common injuries were contusions of the knee in children and sprains of the ulnar ligament of the thumb in adolescents. With increasing age, lower extremity injuries decrease but upper extremity injuries increase.

Soccer

Moderate risk. Overuse and injuries involving the ankle and knee are common. ACL injuries are 2–3 times greater in girls. Long-term disability risk is low to moderate. The incidence increases with age, and injuries are more common in girls. Seventy percent of the injuries are located in the lower extremities, particularly the knee (26%) and ankle (23%). Back pain occurs in 14% of players. Fractures, which account for 4% of injuries, are more often in the upper extremities. Indoor soccer is the most risky.

Swimming

Low risk. Overuse injuries of the shoulder, back, and knee are common, but long-term disability risk is low. Good training and modification of swimming strokes are important in preventing and managing these–problems. Shoulder pain is due to impingement or instability. Preparedness for swimming is optimal between ages 5 and 6 years.

Tennis

Low risk. Acute injuries involving the lower limbs with sprains are the most common injuries. Upper extremity injuries, often due to overuse, are preventable with appropriate training, stroke technique, and equipment. Long-term disability risk is low.

Trampoline

Very high risk. Most injuries occur from falls on hard surfaces to the side of the device. Head and cervical spine injuries are relatively common, and the potential for long-term disability is great. Discourage families from allowing children to play on trampolines.

Strength Training

Low to moderate risk. With proper supervision and low weights, this sport is relatively safe. Overuse is the most common cause of injury. Long-term sequelae are low.

Wrestling

High risk. More injuries occur in large adolescents and more during competition than in practice. The upper limb and knee are the most common sites of injury, and dislocations are more common than fractures. Most injuries are acute sprains. Medial epicondyle fractures, olecranon epiphyseal stress fractures, scapular avulsion fractures, and unusual injury patterns are common. The long-term disability risk is low to moderate.